The Breast

The breasts are made up of glandular tissue, fatty tissue, connective tissue, blood vessels and lymphatic vessels. The glandular tissue contains lobules, which produce breast milk, and milk ducts, which carry milk to the nipple.

It is normal for breasts to vary in size, shape and consistency between individuals and even throughout a person's lifetime. Hormonal changes associated with the menstrual cycle, pregnancy, breastfeeding, menopause and ageing can temporarily or permanently affect their appearance.

Be Familiar with the Normal Appearance of Your Breasts

Current recommendations do not support routine breast self-examination as a screening method. Instead, they promote the concept of breast awareness, which involves becoming familiar with the normal look and feel of your breasts so that you can recognise changes that may require medical assessment.

You should consult a healthcare professional if you notice any of the following signs or symptoms:

  • A new lump or area of thickening in the breast or armpit.
  • A change in the size or shape of one breast.
  • Skin dimpling or nipple retraction.
  • Spontaneous nipple discharge, particularly if it is blood-stained.
  • Persistent skin changes affecting the breast, such as redness, scaling or an "orange peel" appearance.
  • Persistent localised breast pain with no obvious cause.

Most of these changes are not caused by cancer, but they should be properly evaluated.

What Is Breast Cancer Screening?

Mammography screening aims to detect breast cancers before they cause symptoms or can be felt during examination. Early detection makes it possible to identify tumours at an earlier stage, when the chances of successful treatment and cure are greatest.

The screening test used is a mammogram, a low-dose X-ray examination of the breasts.

It is important to remember that:

  • Screening does not prevent breast cancer from developing.
  • Its purpose is to detect breast cancer at an early stage.
  • Screening has been shown to reduce breast cancer mortality among women invited to participate.

Like all screening programmes, it also has some limitations, including:

  • False-positive results.
  • The need for additional investigations.
  • Overdiagnosis of some cancers that might never have caused symptoms during a person's lifetime.

Breast Screening Programme in Spain

The National Health System's population-based screening programme is currently aimed primarily at women aged 50 to 69 years and involves a bilateral mammogram every two years.

Some autonomous communities have progressively expanded the eligible age ranges in line with recent recommendations and local programme organisation.

Women receive regular invitations to participate in the screening programme.

Family History and Inherited Risk

Most breast cancers are not hereditary. However, approximately 5% to 10% are associated with inherited genetic mutations, such as those involving the BRCA1 and BRCA2 genes and other hereditary cancer syndromes.

You should discuss your family history with a healthcare professional if there is:

  • Breast cancer diagnosed at a young age in a family member.
  • Several relatives affected by breast or ovarian cancer.
  • Cases of breast cancer in men.
  • A known inherited genetic mutation within the family.

People at high hereditary risk may require specific surveillance strategies, including:

  • Earlier mammographic screening.
  • Breast MRI.
  • Specialist genetic counselling.

Tests That May Be Performed After a Mammogram or When Symptoms Are Present

If an abnormality is detected on screening, or if symptoms are present, additional investigations may be required.

Clinical Breast Examination

A healthcare professional examines the breasts and nearby lymph nodes to assess for any abnormalities.

Diagnostic Mammography

This may include additional mammographic views compared with routine screening mammography in order to examine a specific area in greater detail.

Breast Ultrasound

Ultrasound uses sound waves to create images of the breast. It is particularly useful for distinguishing solid lesions from cysts and for providing additional information alongside mammography.

Breast Magnetic Resonance Imaging (MRI)

Breast MRI is used in selected situations, particularly in women at high risk, women with dense breast tissue or when assessing the extent of certain tumours.

Breast Biopsy

A biopsy is the only test that can definitively confirm a diagnosis of breast cancer. It involves taking a tissue sample for pathological and molecular analysis.

Frequently Asked Questions

Menopausal Hormone Therapy (MHT)

Menopausal hormone therapy may be associated with a small increase in the risk of breast cancer when used for prolonged periods, particularly certain combinations of oestrogen and progestogen. The decision to use MHT should be individualised after discussing the potential benefits and risks with a healthcare professional.

Breast Implants

Women with breast implants should inform the radiology team before undergoing mammography. Special imaging techniques can be used to visualise as much breast tissue as possible. Mammography remains feasible and safe in most cases.

Age

Age is one of the main risk factors for breast cancer. The risk increases progressively over time, which is why most breast cancers are diagnosed in women over the age of 50.

Anxiety Related to Screening

It is normal to feel concerned while waiting for screening results. Most women who are asked to undergo additional tests are ultimately not diagnosed with cancer. Healthcare professionals can provide information and support throughout the process.

Risk Factors for Breast Cancer

Factors associated with an increased risk of breast cancer include:

  • Increasing age.
  • Family history or inherited genetic mutations.
  • Obesity after the menopause.
  • Alcohol consumption.
  • Physical inactivity.
  • Prolonged hormonal exposure.
  • A personal history of certain breast lesions.